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Close to half of the population will experience neck pain in their lifetime [15]. Poor posture is the number 1 cause of neck pain [4].

In part 1 of this series, I explained how gravity has a language which we are meant to understand. The loss of communication has caused a disconnected relationship, to the point where gravity hurts us physically.

In today’s episode, I will focus specifically on the head and neck.

As you all know, the head rests on the neck (cervical spine) and rib cage. When stacked directly on top of one another, these structures are balanced. If the head moves off axis, the supporting structures get involved in preventing the head from falling off of the body. With gravitational force at play, the head bears more weight on the structures, the further it moves away from the midline [6]. The exact weights were measured in a lab. When the head was at 15, 30, 45 and 60 degrees off axis, the pressure on the neck measured at 27, 40, 49 and 60lb respectively [14]. To think that a neatly stacked head only imparts a load of 10-12lb on the neck!!

The most common off-axis position assumed, is the Forward Head Position (FHP), affecting more than 66% of the population [7].

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Normal vs. Forward Head Position (FHP):

The cervical spine (neck) is supposed to have a natural lordotic curve. A geometric circle is used to represent proper alignment [8] [9]. A forward head position straightens out the natural curve. Often coupled with the FHP is flexion of the neck. The combination puts the spine into a Kyphotic curve, which is opposite to its natural shape. Students and office workers spend a lot of time in this position, due to sitting and working [3]. Physical therapists recommend a neutral or even extended neck position as opposed to flexed [5].

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The implications of a FHP:

Quick fact: The spinal chord, part of the Central Nervous System, runs through the center of the spine.

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Spinal Cord

When the neck spends too much time static or in a kyphosis, it causes narrowing of the spinal cord, known as the Poisson's Effect [8]. The reduced space increases the internal pressure, which makes blood flow in the area more difficult.

Up to 40% less blood flows in the spine during flexion [8]!!

If compression on the chord continues over an extended period, myelin in the nerves starts breaking down, which leads to a loss of signaling to the body. Without secure communication, a whole host of issues could arise, from muscle weakness to autoimmune diseases like multiple sclerosis [8].

Muscles and breathing

Quick fact:The neck contributes to the highest rates of muscular skeletal pain [4].

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High stress in the supporting muscles eventually causes pain. If your head is situated too far forward of the neck, the muscles on the back end (trapezius for example) have to be in constant tension to hold the head's weight. They tire like any other muscles and eventually go into spasm (those knotted balls you feel on your back). This mechanism of muscle tightening is known as protective neck spasms [5].

This is why the associated symptoms with prolonged FHP are: Muscle tension headaches/ migraines and upper cross-syndrome [4] [7]. The correlation between neck pain and FHP is evident.

The scalenes are Muscles situated on the sides and front of the neck. They help bend the neck laterally as well as flex forward. Spending long periods of time in a FHP shortens these muscles. Due to their attachments on the first and seconds ribs of the thorax, they will Negatively affect breathing if compressed too much [11].

In a study, 83% of patients with severe neck pain, had altered breathing patterns [13].

The most significant change in breathing function was a 14% drop in Maximum Voluntary Ventilation (The max amount of air passing through the lungs in 1 min). This particular reduction in pulmonary function is very similar to conditions like Parkinson’s and Multiple Sclerosis, and thus should not be taken lightly [13].

Quick fact: The neck position in small children is of greater importance. A study showed how eight-year-old kids have heads Which are almost fully grown (91%), yet, their supporting neck strength is only 50% developed. This massive discrepancy makes young children prone to neck injury [2].

Psychology

People with faulty postures such as the FHP have higher levels of psychological stress [4]. The stress may be due to living with the acute and chronic pains caused by poor positions and injury [7]. Patients suffering from neck pain also have impaired sleep quality [3]. We all know the psychological effects of not sleeping are dire. Sleep deprivation is even used as a form of torture [16].

Causes of a FHP:

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Downstream problems

As mentioned in part 1 of this series, all the segments of the body interlink to one another. A change in one part may cause an effect on other areas too. A testament to this phenomenon is where a shift in pelvis (hip) position can make a change upstream in the neck. For Those who are interested, it is due to the corresponding Quadratus Lumborum and Scalene muscles which attach on either end of the rib cage, from the hip and neck. A contraction on one end alters the position of the other end, like a domino effect. No wonder Sports therapists like Dr. Kelly Starrett emphasize organizing the body from the feet through to the neck before attempting any sporting movement [1]. You cannot be well organized on one end and slack on the other.

Another example of this circuit is the connection between the shoulders, thoracic spine (upper back), and neck. There is a direct correlation between rounded shoulders and upper back with a forward head position [6]. The chronic case of this is 'upper cross-syndrome'.

Awareness

Lack of positional consciousness is associated with increased neck pain [6]. One of the reasons could be due to a loss of proprioception through nerve degradation, as explained earlier [8] [12].

A study found that when people are distracted, they are more likely to assume the forward head position [6]. In a world where we are fully engrossed in our computer monitors and mobile phone, this makes total sense.

Fixes for a FHP:

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Exercise and stretching

Stretching the scalenes and pectorals will prevent those anterior muscles from pulling the neck and shoulders into the forward, flexed position [7].

Strengthening the rhomboid muscles will also help to retract the shoulders back, taking pressure off of the neck [7].

Proprioception

Balancing exercises are a great way to build awareness of body parts. Balancing light objects, like a ball on the head, will help establish that connection [12] [7].

After some time, more massive objects could be utilized to challenge the balance, and also strengthen all the deep intrinsic muscles [6]. African women have carried baskets and bags on their heads for centuries. The external load forces you to maintain a good posture at all times.

Sleep

Maintaining the normal curvature of the spine during sleep is crucial [10]. The correct usage of a pillow, changes, depending on the sleeping position.

Sleeping on the back requires no use of a pillow to maintain a neutral neck curvature. In fact, the use of too much pillow support may promote a forward head position by flexing the spine.

Sleeping on the side is the most common position [17]. In this case, more pillow support is needed to fill the gap between the shoulder and the head.

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Conclusion:

The language we share with gravity is embedded in the natural alignment of our bodily structures. The neck is no exception, especially since it holds up our 'supercomputer'. It's in our best interest to look after this fragile piece of hardware.

If you are enjoying this series, follow me @exercisinghealth for more.

Disclaimer

This information is not meant to diagnose or treat any medical conditions. Please consult your doctor if you suffer from neck pain or any other spinal issues.

Biblography:

[1]Becoming a supple leopard- Dr. Kelly Starrett [2]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3582332/ [3]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5088155/ [4]https://www.ncbi.nlm.nih.gov/pubmed/18394500 [5]https://www.ncbi.nlm.nih.gov/pubmed/18802224 [6]https://academic.oup.com/ptj/article/87/4/408/2742122 [7]http://journals.sagepub.com/doi/abs/10.1177/0269215511419536 [8]https://www.ncbi.nlm.nih.gov/pubmed/10478773 [9]https://idealspine.com/what-is-cbp/ [10]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5468189/

[11]https://performancesportswellness.wordpress.com/2013/03/15/muscle-of-the-month-the-scalenes/ [12]https://www.hindawi.com/journals/bmri/2015/689610/ [13]http://journals.sagepub.com/doi/abs/10.1111/j.1468-2982.2008.01787.x [14]http://www.jptrs.org/journal/view.html?doi=10.14474/ptrs.2016.5.2.101 [15]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3489448/ [16]http://www.optalert.com/news/sleep-deprivation-as-a-form-of-torture [17]https://sleep.org/articles/best-sleep-position/ *All images were created by @exercisinghealth